Medication Relatedness Determinations and Hospice Formularies: Understanding the Essentials


The percentage of Medicare hospice beneficiaries billing Medicare Part D for one or more maintenance drugs was 71.3% in 2013, dropped to 50.8% in 2014 and made an unanticipated rise the subsequent year to 62.7%.  To address this increase, CMS is analyzing how maintenance drugs are incorporated into hospice care plans and why these drugs are ‘not being coordinated and paid for by hospice beneficiaries’. CMS maintains that virtually all medications should be covered under the hospice benefit and it is the rare instance that Medicare Part D is billed for medications. At the end of this course, the attendee will recall the recommendation that hospice reports all diagnoses, whether related or unrelated to the terminal prognosis, including mental health disorders and conditions that would affect the plan of care. In addition, hospice covers all related and helpful medication therapy and documents rationale for medication non-coverage determinations.


Hours: 0.75


Certificates provided by accrediting body (4 Match)

American Nurses Credentialing Center

0.75 HOURS

Relias, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Nurses will receive 0.75 contact hours for participating in this course.

District of Columbia Board of Nursing


DC-RN -- District of Columbia Board of Nursing Approved Continuing Education program (CE Provider #50-290).

Nurses will receive 0.70 contact hours for participating in this course.

Georgia Board of Nursing

0.75 HOURS

Georgia Board of Nursing CE Provider #: 50-290

Nurses will receive 0.75 contact hours for participating in this course.

South Carolina Board of Nursing

0.75 HOURS

This program was approved by the South Carolina Board of Nursing Approved Continuing Education Program (CE provider #50-290) CE Broker Course # 20-[Custom_Code]

Course Details

Hours: 0.75
Type: Online Course
Content Expiration Date: 10/31/2021
Learning Objectives:
Describe Centers for Medicare and Medicaid (CMS) hospice medication coverage regulations
Recognize differences between formularies and hospice coverage
Outline steps in making medication coverage determinations in hospice

Medication Relatedness Determinations and Hospice Formularies: Understanding the Essentials


CMS Regulations regarding Medication Coverage

FY 2016 “Final Rule”

Payment Responsibility for Non-Beneficial Medications

Payment Responsibility for Non-Formulary Medications

Four Buckets of Medication “Relatedness”

Medications Always Covered

Drugs Never Covered by Part D or Hospice

Examples of Medications Usually Not Covered

Examples of Non-Palliative Drugs: Consider Discontinuing

Common Formulary Alternatives

Relatedness: Admission Nurse’s Role

Relatedness: Medical Director’s Role

Relatedness: IDG Role

Determination of Hospice Medication Coverage

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

More Documentation Examples

Documenting Related, But Not Covered

Step 8

Case Example: Mrs. G.

Assessing Terminal Prognosis

Related Co-Morbidities

Related Secondary Conditions

Determining Relatedness

Mrs. G’s Med Profile

Four Buckets of Medication “Relatedness”

Medication Review Summary

Summary of Coverage Responsibility

Best Practices

Resources and Links

Contact Information

Instructor: Terri Maxwell, PhD, APRN
Terri Maxwell, PhD, APRN, is Chief Clinical Officer of Turn-Key Health, a division of Enclara Pharmacia. A frequent presenter at state and national meetings, Terri is a well-published author on a range of palliative care topics.  She obtained her BSN from the University of Rhode Island and a Masters Degree and PhD in Nursing from the University of Pennsylvania. Disclosure: Terri Maxwell, PhD, APRN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Nurses; in the following settings: Palliative Care, Hospice.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.